Clinical Outcomes of Dacryocystorhinostomy With or Without Intraoperative Use of Mitomycin C: A Systematic Review and Meta-Analysis

Purpose: To examine the possible benefit of intraoperative use of mitomycin C (MMC) application in dacryocystorhinostomy (DCR) and to assess its potential risk. Methods: Systematic review and meta-analysis of randomized-controlled trials (RCTs). A comprehensive literature search was performed according to a protocol set in advance. The participants included 811 patients of which 820 eyes were sampled for 14 RCTs. Only pertinent RCTs were identified and included in this meta-analysis. The primary efficacy measure was patency of irrigation at follow-up end point. The subjective outcome of symptom relief was also extracted as a secondary efficacy measure. For each study, relative risk was extracted. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. Results: RevMan version 5.0 software was used for statistical analysis. In the primary efficacy measure, the use of MMC can significantly increase the rate of patency of irrigation [risk ratio (RR), 1.10; 95% confidence interval (CI), 1.04-1.17; P=0.0006]; the outcome of symptom relief was also affected by the use of MMC (RR, 1.15; 95% CI, 1.05-1.26; P=0.003). Sensitivity analysis suggested that the result was comparatively reliable. Conclusion: Intraoperative use of MMC can bring about a positive effect to the outcomes of patency of irrigation and symptom relief, which increases the success rate of DCR surgery.